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Have you ever gotten a crack or fissure at the corner of your mouth that was painful, annoying and yucky looking? Well, with all of my travels as of late and spending 5 days in the gorgeous and incredibly arid southwest- my lips got super dry and I got a crack in the corner of my mouth and it hasn’t healed yet. As I’m going into family practice I love medical issues like these that plague and bother folks but are not as sexy to manage as more complicated and exotic stuff.

Saliva is the enemy- at least for mouth cracks. What happens is that in young folks you get an initial insult from wind chapping, thumb sucking, agressive flossing, or perhaps even a cold sore or zit. Older folks may be missing teeth or have diminished facial muscle tone from stroke or may simply have wrinkles in the wrong place. Then, saliva comes into play- capillary action draws fluid from the mouth into the fold and causes chapping, fissures, redness, oozing, and secondary infection with Candida organisms and/or staphylococci. The infection causes a sore fissure in a deep part of the skin fold. The sides of the fold or fissure will get crusty and red. To feel better, folks will lick the area and moisten it to prevent the painful cracking sensation upon opening or moving the mouth. Also- the spit situation is even worse in a person who normally mouth breathes or is super congested and has to mouth breathe.

Treatment Usually a combo of antifungals and steroid creams are employed. The antifungal is put on first (2-3 times a day) to get at the candida and the steroid cream (hydrocortisone is a good one- go for 1% which can be over the counter) is applied several hours later. If its really bad and there seems to be a pretty raging bacterial infection then a topical or oral antibacterial can be used. I’m going for an over the counter jock itch cream with fluconazole in it followed by an over the counter 1% hydrocortisone cream. I can stop when the redness and discomfort subsides but then I’ll be using pretty heavy duty lip balms to protect the area from spit. I know that there are good anti-fungal herbal treatments out there but I am not familiar with them otherwise I would suggest them- anyone want to school us in the comments section??